Service Coordinator III Valley Job at Driscoll Health
Where compassion meets innovation and technology and our employees are family.
Thank you for your interest in joining our team! Please review the job information below.
General Purpose of Job:
This position provides administrative and technical support to Driscoll Health Plan’s Case & Disease Management’s Case Managers, Social Workers, Resource Coordinators and Health Education Coordinator. Additionally, this position provides technical support to the Case and Disease Management Departments (CMDM) and the Utilization Management Department (UM) to ensure all referrals/authorizations assigned, phones calls, reports are addressed and completed in a timely manner.
Essential Duties and Responsibilities:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the immediate supervisor and/or hospital administration as required.
- Service Coordinator III are not responsible for conduction any UM review or CMDM activities that require interpretation of clinical information including non-certification of requests. Licensed health professionals are available for oversite.
- Review authorization requests for completeness of information.
- Maintains utmost level of confidentiality at all times.
- Adheres to hospital policies and procedures.
- Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
- Requires outstanding communication skills and the ability to deal tactfully and empathetically with co-workers and customers.
- Knowledge of Medicaid managed care and health plan processes preferred.
- Medical terminology preferred.
- Prior medical office or hospital experience preferred.
- Requires the ability to understand complex situations and interpersonal dynamics so as to effectively handle escalated customer needs.
- Requires a well-organized individual with an excellent capacity for effective time management.
- Ability to establish and maintain effective working relationships with the staff and peers.
- Demonstrates ability to operate personal computer programs, excel spreadsheets, complex medical management software, mail merges and meeting minutes.
- Excellent Microsoft Office skills.
- Excellent communication skills.
- Service Coordinator III are not responsible for conducting any Utilization Management (UM) review or CMDM activities that require interpretation of clinical information including non-certification of requests. Licensed health professionals are available for oversight.
- Ability to work independently and as part of a team.
- Responsible for monitoring all messages left on the CMDM toll free phone line. Answer Automated Call Distribution (ACD) line during mandated hours of operation (8am to 5pm CST).
- Assist in collection of structured clinical data and input of various types of information into the complex Medical Management System.
- Collection and transfer of non-clinical data and input of various types of information into the complex Medical Management System.
- Review authorization requests for completeness of information.
- Process complex authorization requests according to decision-making tool (Authorization Guide) to include forwarding information to nurses and medical director as appropriate.
- Maintain authorization and telephone turn-around-time stats.
Education and/or Experience:
High school diploma or general education degree (GED.
Two (2) years prior experience in a managed care organization or medical setting preferred.
Medical Terminology preferred.
Excellent Microsoft Office skills required.
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